Community based older persons, especially those with functional limitations and disability, use a variety of health care providers to maintain and/or improve their health and functional capabilities. Physical and occupational therapists represent one group of health care providers that primarily focus on improving, maintaining, or limiting decline in the functional capabilities of the older person. The broad objective of the proposed study is to advance our understanding of the access to and effectiveness of physical and occupational therapy for community based older persons. This study will be population based, analyzing several years of data from the Medicare Current Beneficiary Survey. The first aim of the study is to identify determinants of therapy use. Analyses will be conducted to identify predisposing, enabling, and need characteristics associated with the use of physical and occupational therapy. Determinants of therapy use in the home or outpatient setting will also be identified. And finally, the relationship between predisposing, enabling, and need characteristics and intensity of therapy use will be examined. The second aim of the study is to examine the relationship between therapy use and changes in functional status. Users of physical and occupational therapy will be identified and analyses will be conducted to examine the relationship between intensity of therapy use and changes in functional status, while controlling for patient characteristics and illness severity. The feasibility of examining changes in functional status among users and nonusers of physical and occupational therapy will also be explored using instrumental variable estimation or a case-control approach. Little is known about whether community based older persons have appropriate access to therapy services. Data on the effectiveness of physical and occupational therapy for community based older persons is also limited. Because recent changes in Medicare reimbursement have had a direct impact on the provision of therapy services, examining issues surrounding the use and effectiveness of these services is timely and may inform future Medicare policy.